Transcript Work together as a Team!!!! 2013 Unit Goal

CCU Unit Meeting
January/February 2013
I Dare you to…
Work together as a Team!!!!
2013 Unit Goal:
Focus on Teamwork and improving
the Workflow on the unit – Lets
agree to work TOGETHER AND
MORE EFFICIENTLY!!!
Welcome/Congratulations
• Please welcome:
Dana Mullins, NA
Ashley Eckroate, NA
Marina Verbosky, RN
Clinical pharmacists: Beth Apanasewicz and
Rachel Wagner
3 new nurses hired this week- will start in
February!!!
Congratulations
Hello All,
Aultman was named a top 100 heart
program by Becker’s Hospital Review!
Congratulations!
Thanks! Anne
Anne Gunther, MSN, RN, NE-BC
Chief Nursing Officer
Aultman Hospital
2012 CCU Recap
Total Patients
CCU
15,050 budgeted 14,957
Average PPD 41
CPC
1749 Budgeted 1608
Observations *
ADM
7-3
ADM
3-11
ADM
11-7
Discharge
7-3
Discharge
3-11
Discharge
11-7
Period 1
179
130
73
Period 1
166
212
8
Period 2
173
156
63
Period 2
156
213
1
Period 3
159
165
85
Period 3
179
204
7
Period 4
138
173
82
Period 4
131
243
0
Period 5
185
156
65
Period 5
181
196
1
Period 6
169
122
83
Period 6
181
189
1
Period 7
176
132
53
Period 7
155
185
3
Period 8
155
144
67
Period 8
152
251
1
Period 9
167
147
88
Period 9
190
207
3
Totals
1501
1325
659
1491
1900
*Admissions on weekdays
•
8 per day shift / 7 per afternoon / 1.5 per night shift
*Discharges
•
6 per day shift / 9 per afternoon / .5 per night shift
*More volume takes place on Afternoon shift
*PATIENT LOAD PEAKS FROM 2P-7PM IN REGARD TO BOTH DISCHARGES , ADMISSIONS, POST
PROCEDURE RECOVERY
*ED admissions are at a peak from 2p-4p, they are arriving on the unit at time of shift change.
25
Total Admissions Per Shift
Total Discharges per Shift
Adm/Discharges 7-3 shift
Adm/Discharge 3-11 shift
300
Admissions &
Discharges on
3-11pm
250
200
ADM
3-11
Discharge 3-11
150
100
Analysis:
More discharges on 3-11
than admissions, more
load on this shift.
50
0
Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7 Period 8 Period 9
Adm/Discharge 11p-7a shift
Customer Service Initiative
• Coming soon to hospital is
training in Customer Service for all
employees.
• Handouts are proposed overview
• Remember – Patients and their
families always come first!
Unit Fundraisers for Adopt a
Family
• Jackie Halter & Barb McAviniew have agreed to work with
other interested staff members to conduct unit based
fundraisers, soup kitchens, raffles, etc….
• Please stay tuned as they will be sending you emails to donate
and participate!!!!
• We also need some volunteers to work on a CCU Christmas
Party for 2013!!!
• Thanks for all you do!!!
Recognition: Cardiac Rehab
Staff
• In recognition of Cardiac Rehab week is Feb 11-15th, CCU is
sending them a “thank you” card.
• Please sign if you have not already.
• We will be recognizing various teams throughout the year and
will communicate.
• Thank you to Shared Decision Making for supporting this
recommendation from the Recognition Council
Clinical Practice
Don’t forget:
the “Did You
Know” handout
includes items
emailed this
past month and
will be posted
as “stall talk”
“Clicker” orientation: The 2013 CCU shared
decision making chair/co-chair are:
1. Jodi Edmunds/Amy
Mutchler
2. Mickey
Mouse/Donald
Duck
3. Amy Mutchler/Chris
Dunbar
0%
4. I do not know
1
0%
0%
2
3
0%
4
Sheath Pulling Documentation
(Vascular Complications)
• Use “Lines and Procedures” to document presence of sheath
and sheath care PRIOR to pull
 Include name of nurse who is pulling (flagged comment)
 Number of minutes pressure held
• Once sheath is pulled, use the interactive view (wound
section)
 While pressure is being held – select “manual” or “c clamp”
 After pressure and dressing applied – select “procedure site”
• Measure and document size of hematomas
When getting your OHS patient ready
for surgery, apply a new set of
disposable leads for each CHG prep.
1. True
2. False
Apply one set of
disposable leads with
the first CHG prep.
Apply new
electrodes/gown
with EACH CHG prep.
(NEW) Disposable
leads to be used for
the IABP patient.
0%
1
0%
2
Your feedback: Transport is providing a courtesy call to the unit
when returning a patient to their room. (Practice Council)
1.
2.
3.
4.
5.
Always
Usually
Seldom
Never
Not application to
my role in the unit
0%
0%
1
2
0%
0%
0%
0%
3
4
5
6
I have noticed an improvement in the
accuracy of the home medication list (med by
history) for ED admissions.
1.
2.
3.
4.
Yes
No
Not sure
Not applicable to
my role in the unit
0%
1
0%
0%
2
3
0%
4
New Trials/ New Processes
• STEMI process for main part of hospital approved as
part of the Rapid Response Team.
STEMI team alerted by sending unit
Patient will be transferred over to CCU STEMI bed
CCU to take STEMI patient to cath lab when cath
team arrives (please communicate to cath lab
charge nurse if we need help)
• Coming: Sacral Dressing Trial for OHS population
• R Band Trial: slightly different version of the TR band.
Can lock in specific amount of air to be released.
See handout
Education
• 2013 RN Clinical Goals (from 2012 competency) have been emailed
• 2013 CPR
 Option to complete electronically with demonstration portion in
CCU education room (will be offered quarterly)
• “Finding the Patient Education Remedy: Medication Communication
and the ‘Teach Back’ Technique” on Wed, February 20th 5-8pm.
(Annual Patient Education Symposium)
• 2013 Novice to Expert Classes (see calendar/education profile card)
OLD
NEW
Level 1
Beginner Practitioner (Step down
orientation)
Level 2
Advanced Beginner Practitioner (ICU
orientation)
Level 3
Proficient Practitioner (ICU orientation)
Level 4
Expert Practitioner (Certification Prep
Course)
Level 5
Master Practitioner (Certified Staff)
Beyond the Core
Staff who have completed the Novice to
Expert Curriculum
Education
• Expectations:
• If you are an ICU trained nurse you must complete or have
completed Advanced Beginner Practitioner classes by the end of
2013.
• You must also complete Proficient Practitioner by spring 2014.
• These classes are considered to be part of your orientation
process.
• Certification course – the hospital will pay for the exam and offer
an online review course at no charge.
• See Rhonda after unit meeting for your 2013 plan
Patient Education
• Keep up the good work with HF education
documentation!
• CPAP:
If patient uses at home, ask if family will
bring it in
Notify physician/APN so it can be ordered
here
• New patient education handout
Sleep Apnea
What time of day does a
“statin” best work?
1. During the morning
2. During the
afternoon
3. During the evening
4. I do not know
0%
1
0%
2
0%
3
0%
4
Which of the following “statin” side effects
should the patient report to his/her
physician?
1.
2.
3.
4.
Joint pain
Muscle Aches
Headache
Upset Stomach
0%
1
0%
2
0%
3
0%
4
Based on the lab values below, when
would you consider holding a “statin”?
1.
2.
3.
4.
Low LDL
Elevated LFT
Elevated creatinine
Elevated
triglycerides
0%
1
0%
2
0%
3
0%
4
Medication Education Tips
• Teach in ‘pairs’ – similar action/side effects (ie ASA and plavix)
• Highlight new medication on the discharge medication list
• Use “living room” language
 Statins: there is good cholesterol and bad cholesterol. This
medication helps to keep the bad cholesterol at a low level. This
will help to prevent another heart attack in the future.
CI Education Topics (First Quarter 2013)
Topic
Date Education
Available
Audience
Method of
Education
724Access Cerner
Downtime Viewer
12/27/2012
Units with Cerner
Downtime Viewers
Handout
Glucophage/
Contrast
1/3/2013
Nursing, Radiology
Techs, Pharmacy,
Physicians, Heart Lab
Handout
2012 Code Upgrade
1/14/2013
All Cerner End Users
Learning Management
System
Allscripts Bed
Management
2/4/2013 Expert User
Training Sessions for UD
and PCS staff
Nursing (Inpatient), Bed
Management, Admitting,
Registration, Transport,
Procedural Areas
Train the Trainer and
Learning Management
System
LTACH- Cerner EMR
2/11/2013 Super Users
2/24/2013 End Users
All LTACH Staff
Learning Management
System and Classroom
Electronic Discharge
Instructions
TBD
Nursing, Medical
Records
TBD
Past Medical
History/Problem List
TBD
Nursing, Physicians
TBD
Allscripts Bed Management
• February 22nd
• Electronic management of admissions and
discharges
• Changes will need to happen in the unit
• Lead nurses will be converting to an electronic
method of bed management and assignments
• Nursing will be receiving alerts as to patient
admissions
• Discharges will become visible immediately in
ED
When giving the patient his/her discharge
instructions it is “OK” to ‘write in’ information
such as a follow up appointment?
1. True
2. False
If not part of the
electronic chart, there is
nothing to protect you or
show that this was
provided to the patient.
0%
1
0%
2
Operational Items
Quality Initiatives
Getting to Zero – Main Hospital
MICU
SICU
MEMORIAL 4 EAST
MEMORIAL 4 NORTH
MEMORIAL 5 SOUTH
MEMORIAL 5 NORTH
MAIN 5
MEMORIAL 6 NORTH
MEMORIAL 6 EAST
MEMORIAL 6 SOUTH
MEMORIAL 4 SOUTH
CCU
CVSICU
CVSD
PSYCHIATRIC
RADIATION THERAPY
RADIOLOGY
DIALYSIS
INFUSION THERARPY
HALLWAY/OTHER
ER
LDRP
LABORATORY
OUTPATIENT LABORATORY
PEDIATRICS
RESPIRATORY THERAPY
RECOVERY ROOM
HEART LAB INVASIVE
HEART LAB NON-INVASIVE
CHEST PAIN CENTER
NICU
CARDIAC REHAB
CARDIAC SAME DAY
WOUND CARE
SAME DAY
CARDIOVASCULAR SURGERY
SURGERY
TOTALS
NA = not applicable ND = no data
MISID'D
ALL FALLS
SPECIMENS HAND HYGIENE
Dec 12 YTD Dec 12 YTD Dec 12 YTD
1
4
1
12
ND
91%
0
7
0
7
ND
96%
0
21
0
6
ND
85%
1
31
0
3
ND
93%
0
13
0
5
45%
82%
1
22
0
0
60%
85%
0
14
0
2
100% 100%
0
16
0
1
75%
86%
0
11
0
2
ND
95%
1
27
0
4
91%
93%
0
2
0
0
ND
100%
1
32
0
5
ND
85%
0
0
0
13
ND
64%
0
8
0
4
ND
75%
4
43
0
0
ND
100%
0
1
0
0
ND
ND
1
12
0
3
ND
ND
1
1
0
1
ND
100%
0
3
0
1
100% 98%
1
9
3
53
NA
NA
0
17
0
40
ND
100%
0
10
2
44
ND
97%
NA
NA
0
16
ND
ND
NA
NA
0
1
ND
ND
0
1
0
1
ND
100%
0
0
0
3
ND
80%
0
0
0
1
70%
53%
0
0
0
2
ND
100%
0
0
0
0
ND
100%
0
0
0
1
ND
100%
0
0
1
17
ND
100%
1
6
0
0
ND
ND
0
0
0
2
ND
ND
0
0
0
0
ND
82%
0
1
0
3
100% 52%
1
0
14
1
0
313
0
0
7
1
7
261
ND
53%
75%
75%
NDNQI
NDNQI SKIN
RESTRAINTS
BREAKDOWN
CLABSI
SSI
Q3 12 2012 Q3 12
2012 Dec 12 YTD Dec 12
47%
39%
0.00%
5.55%
1
2
0
21%
18% 16.67% 8.58%
0
3
0
13% 5.34% 17.39% 10.92%
0
1
0
7.14% 6.12%
0%
0%
0
0
0
0%
1.67% 0.00%
2.77%
0
1
2
0%
0%
0%
0%
0
0
0
0%
0%
0%
0%
0
0
0
0%
0%
0.00%
2.90%
0
2
0
0%
0%
5.26%
3.50%
0
0
0
0.00% 2.08%
0%
0%
1
1
0
ND
ND
ND
0%
0
0
0
4%
1%
0%
0%
0
0
0
0
0%
0%
0%
0
1
0
0.00% 2.87% 28.57% 15.08%
0
0
0
0%
0%
0%
0%
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
6
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
1
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
ND
NA
ND
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
2
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
Hospital Acquired
0
0
2
0
0
19
0
0
3
CAUTI
VAP
YTD Dec 12 YTD Dec 12 YTD
0
0
2
0
0
3
0
9
0
1
0
0
5
0
0
0
0
2
0
0
13
0
1
0
0
0
0
0
0
0
15
0
0
0
0
1
0
1
0
0
20
0
1
0
0
3
0
0
0
0
0
0
0
0
0
1
0
2
0
0
3
0
1
0
3
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
77
0
0
0
0
0
24
0
0
0
0
0
5
Core Measures
• AMI – 100% (potentially 1 fallout)
• Heart Failure – 96% preliminary (CCU – 2 fallouts)
• Nurses forgetting to sign the depart process
• SCIP – Not finalized around 92%
• CCU – twice nurses gave antibiotic prior to surgery on
the unit. Should go on the chart to surgery.
• Pneumonia – 94.9 (CCU 3 Fallouts)
• CCU – make sure to classify a patient at high risk when
they have a diagnosis of Heart Failure or Asthma – age
does not matter.
Joint Commission Audits
• We passed the practice walk through!!!
• GREAT JOB!!!!
• Opportunities
•
•
•
•
Advanced directives – not on charts -47% compliance
Insulin bottle not labeled with date and time
Missing signed areas on code blue carts
Handwashing – we have slipped in past month
• Nurses and aides seen forgetting to use purell prior to entering room
to take vital signs and temps!
Noise Audit
• Patient room doors open in the middle of night
• Nurse doing cardiac rehab at 5:30am
• Alarms ringing loudly while a nurse was reading a book
on an IPAD.
• Nurse yelling down the hall to coworker at 4:30am
Please be aware of what your patients are hearing and
seeing you do. There should never be anyone reading a
book or newspaper at the nurses station. Spend the
extra time to clean up the station, look up patient
history, and complete baths on those complete patients
who are awake and confused.
12 Hour Shift Guidelines
• 12 hour shift guidelines
• See the new hospital guidelines / scheduling
• Sign the agreement due immediately
• Minimum # of 12 hour shifts you need to work
to be able to work every 3rd weekend
• Interest in 3a/3p shift – let Rachel know.
• Interest in increasing hours – let Rachel know.
2013 Yearly Evaluation Process
•
•
•
•
•
•
Begins February 1st
Rhonda, Myself and Assistant Manager to deliver evaluations
Assistant Managers will have staff assigned to them
Goal is to get your feedback and reflect upon the last year
Identify your development goals
Increase of 1.5% wage adjustment increase for all levels, and
will be granted at scheduled time of evaluation.
• Assistant manager will be contacting you to set an
appointment for your evaluation.
• January and February evals will be done over the next 6
weeks.
Pharmacy Project
• Discharge Strategy
• HUDDLE - Pharmacist, APN, Team Leader Nurse, Case Manager, to
meet starting on POD 1 at 8:30am daily – work around to pod 5
• Discharges should be called to the lead immediately
• Discharges should be called to the Pharmacist IP Phone
Immediately
• Med Req for discharge needs to be done early in am
• Pharmacist will educate the patient regarding their medications,
discharge meds, side affects and also work with physicians
regarding patient meds issues and needs.
• Nursing must check the discharge med req to make sure there are
3 green checkmarks, and verify accuracy DO NOT RELY ON THE
DEPART MEDICATION LIST – HAS BEEN WRONG.
• Nurses will complete the discharge process, final review of meds.
Pharmacy Project
• Goal
• Best Prepare our patients in medication safety and enhance their
understanding of how to take medication properly.
• Improve HCAPS scores:
• readiness for discharge
• Side affects and medications were explained to me.
• Offer help to the point of care nurses, removing the task of
discharge, expedite discharges
• Promote earlier discharges to prevent the waiting list of patients.
• Plan to have assistant managers facilitate the discharge process
initially until structure is developed for consistency.
How do you check to see if your IV medication is
ready in Pharmacy?
1. Call pharmacy
2. Call Jim Toohey
directly
3. Refer to the
dosedge icon on
your desk top
4. I do not know
0%
1
0%
0%
2
3
0%
4
I can use my curser to hover over my patients medication on
the EMAR to see detailed information that the physician or
pharmacist has included.
1. True
2. False
0%
1
0%
2
All patients on the unit should have an accurate
intake and output recorded every shift? (Dr. Dopirak
made me ask this!)
1. True
2. False
0%
1
0%
2
I record information about my patients
wishes for privacy disclosure in/on:
1. Clinical notes in
CERNER
2. Printed privacy
paper
3. Admission history
privacy
communication
information tab
4. I do not know
0%
1
0%
0%
2
3
0%
4